Key result
ARBs are linked to improved intrarenal resistance index only in hypertensive patients with significantly reduced proteinuria.
Why the study?
Does ARB improve intrarenal hemodynamics measured by Doppler ultrasonography in hypertensive patients with renal insufficiency?
Observational (n=30)
Does ARB improve intrarenal hemodynamics measured by Doppler ultrasonography in hypertensive patients with renal insufficiency?
ARB therapy improves intrarenal hemodynamics, which correlates with its renoprotective effect (reduction in proteinuria) in hypertensive patients with renal insufficiency.
May link ARB response to intrarenal hemodynamics in proteinuria reducers; leaves open randomized confirmation and broader applicability.
AIMS: It has been shown that both angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II type 1 receptor blockers (ARB) have renoprotective effects via mechanisms that are independent of blood pressure reduction. The aim of this study was to evaluate the intrarenal hemodynamic change with ARB by renal Doppler ultrasonography (RDU) and to assess the mechanism of ARB in patients with hypertension. METHODS: Thirty hypertensive patients with renal insufficiency caused by glomerular diseases, diabetes and hypertensive nephrosclerosis were included in this study. RDU was performed before and one week after taking ARB. Resistance index (RI) (peak systolic velocity - end diastolic velocity/peak systolic velocity) in the intrarenal segmental artery were calculated, and the amounts of urinary protein or albumin were determined. RESULTS: We defined patients whose microalbuminuria or proteinuria was reduced by greater than 30% by ARB as responders (n = 22) and defined other patients as non-responders (n = 8). There were no significant differences between the responder and non-responder groups in baseline characteristics. RI was significantly improved by ARB in the responder group, but not in the non-responder group. The reduction of RI after ARB treatment was most prominent in patients with hypertensive nephrosclerosis. CONCLUSIONS: Improvement in intrarenal hemodynamics might play an important role in the mechanisms of the renoprotective effect of ARB in patients with hypertension.
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Ogata et al. (2005) conducted an observational in Hypertension with renal insufficiency (n=30). Angiotensin II type 1 receptor blockers (ARB) vs. Baseline (before treatment) was evaluated on Resistance index (RI) in the intrarenal segmental artery and urinary protein or albumin. Angiotensin receptor blockade improved the intrarenal resistance index in hypertensive patients with >30% reduction in proteinuria (n=22), but not in non-responders (n=8).
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